Chronic Disease

For hypertensive patients with diabetes, blood pressure drops quicker with more frequent interactions with clinicians

High blood pressure is one of the major risk factors for microvascular and macrovascular complications in patients with diabetes, which lead to kidney, eye, and other problems. It is recommended that patients with elevated blood pressure see the doctor every month to keep blood pressure under control. However, a new study found that patients with hypertension and diabetes who had provider encounters (face-to-face or otherwise) less than 2 weeks apart had the fastest decrease in blood pressure. Blood pressure of the patients with an average encounter interval of 2 weeks or less normalized after a median of 0.7 months, compared with 1.9 months for the average encounter interval between 2 weeks and 1 month. Possible explanations for the decreases in blood pressure include a greater number of opportunities for treatment intensification as well as improved treatment adherence, note the researchers.

Alexander Turchin, M.D., M.S., and a team of Boston researchers conducted a study of 5,042 hypertensive patients with diabetes who were treated at 2 academic hospitals between 2000 and 2005. The median age of study patients was 65 years; the majority were women. On average, patients were followed for 4 years during the study. Their blood pressure was above the recommended target (129/84 mm Hg) for more than 60 percent of the time.

The researchers point out that shorter encounter intervals may be difficult to implement in practice. Most hypertensive patients are treated by their primary care physicians, and the nationwide shortage of these providers is likely to only grow in the future. They suggest that if shorter encounter intervals are to be achieved, more creative approaches to patient care may be needed. This study was supported by the Agency for Healthcare Research and Quality (HS17030).

See "Encounter frequency and blood pressure in hypertensive patients with diabetes mellitus," by Dr. Turchin, Saveli I. Goldberg, Ph.D., Maria Shubina, Sc.D., and others in Hypertension 56, pp. 68-74, 2010.

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